Results A total of 605 study participants were involved with a response rate of 96.5%. Among them, 317 (52.4%) participants were males. The mean age of the respondents was 38.18 ± 15.56 with a range of (18-95) in years. The overall prevalence of pterygium was 112 (18.5% (95% CI (15.6-21.7)). Being widowed (AOR = 7.32 (95% CI 2.88, 18.57)), outdoor occupation (AOR = 2.50 (95% CI 1.46, 4.29)), sun exposure (AOR = 2.38 (95% CI 1.28, 4.43)), wind exposure (AOR = 1.97 (95% CI 1.04, 3.72)), alcohol drinking (AOR = 2.26 (95% CI 1.48, 4.63)), and severe blepharitis (AOR = 2.45 (95% CI 1.48, 4.05)) had statistically significant positive association with pterygium. Conclusion The prevalence of pterygium was relatively higher. Being widowed, outdoor occupation, sun exposure, wind exposure, alcohol drinking, and severe blepharitis were significantly associated with the development of pterygium. © 2020 Kassie Alemayehu et al.BACKGROUND Results-based funding models can improve Vocational Rehabilitation (VR) client employment outcomes, but evidence suggests that gaps in services occur when provider risk is not compensated. OBJECTIVE The purpose of this qualitative study is to learn how VR agencies deliver and pay for job development and placement services, the factors that shape decision-making, and the outcomes of such decisions. METHODS Administrators from 40 VR agencies identified informants to take part in qualitative interviews about how their agency delivers, contracts, and pays for job development services. Interview notes were analyzed to identify themes and dimensions in the data. https://www.selleckchem.com/products/a-1155463.html RESULTS Gaps in provider services exist in rural communities, where provider risk is increased due to economic, transportation, and delivery barriers. Strategies to overcome barriers focused on expanding available providers by lowering requirement for provider entry, increasing recruitment activities by the VR agency, reducing financial risk in the form of incentives, tiered payments, and shared funding models, and increasing agency capacity and support. CONCLUSIONS Strategies for effective VR service delivery are shaped by multiple factors and choice points at the agency level. A deeper understanding of the intended and unintended consequences of service delivery models is an important contribution to informed decision-making.Very few cases of simultaneous occurrence of tibial tuberosity fracture with lower pole patella and distal patellar tendon rupture type injuries have been reported in adolescent athletic age group, but its occurrence in osteogenesis imperfecta (OI)* has not been reported to the best of our knowledge in a literature search of last 5 years in the English Language. The mechanism of avulsion injury after low-velocity trauma and the underlying pathology is a unique combination in our patient and a note on updates in general management of osteogenesis imperfecta is discussed. © 2020.Pycnodysostosis is a rare inherited disorder of autosomal recessive trait causing cathepsin K deficiency, leading to failure of osteoclastic activity. Brittle and sclerotic bones which are prone for frequent fractures is the characteristic feature of this congenital disorder. Despite good healing potential there are few issues in the management of fractures in pycnodysostosis patients. In this article we report the challenges faced in managing a fracture of the femoral shaft in a 12 year old girl with pycnodysostosis. For early rehabilitation and to avoid deformity and shortening, we opted for surgical fixation over conservative treatment. Narrow medullary canal ruled out the option for titanium elastic nail fixation. 4.5mm dynamic compression plate was used to fix the fracture. Sclerotic bone made drilling extremely difficult. Deformed femoral shaft allowed plating over the anterior surface only, instead of the routine lateral surface plating. Postoperative fracture healing was satisfactory. Implant was removed after 18 months. © 2018.Septic Arthritis of the wrist is rare in the paediatric population due to its extraarticular metaphysis. We report here a case of wrist septic arthritis in a neonate caused by an uncommon causative organism, Streptococcus cristatus. A 15 days old male child was referred with the complaint of swelling and decreased movement of the left wrist for 5 days. Local examination revealed warm, tender, erythematous and fluctuant swelling over the dorso-ulnar aspect of the left wrist. Ultrasonography of the affected region was suggestive of focal fluid collection in the wrist and periosteal elevation of the distal ulna. Aspiration followed by arthrotomy of the wrist joint was performed and multiple holes were made in the distal ulnar metaphysis using 0.8mm k-wire. The pus culture was positive for Streptococcus cristatus, sensitive to vancomycin, which was given for a total of 4 weeks. At one year follow up the child had a full, painless range of motion with no functional deficit. Final follow up x rays of the left wrist were normal. Streptococcus cristatus strains are described as Gram-positive, catalase-negative cocci, approximately 1 μm in diameter growing in chains and were originally isolated from the human throat and oral cavities. Its association with bone and joint infections has not been described in the literature. To our knowledge, this is the first case of isolated septic arthritis of wrist in a 15 days old child caused by Streptococcus cristatus. To conclude, wrist septic arthritis in a neonate is a rare entity. With the advanced diagnostics, species-level identification of rare organism like Streptococcus cristatus is possible along with antibiotic sensitivity for appropriate therapy. Early surgical decompression and intravenous culture-directed antibiotics are the mainstays of management. © 2019 Delhi Orthopedic Association. All rights reserved.Radial neck fractures account for 1% of all paediatric fractures and constitute 5-10% of elbow injuries. Radial neck fractures rarely occur at age 2 or less. It is difficult to assess and reduce radial neck fractures in children with unossified radial head. We report a case of 2 years old female child presented to emergency with history of fall from stairs on an outstretched hand. Radiograph showed a metaphyseal spike in the proximal radius which prompted us to think of a radial neck fracture. Since the radial head was not ossified, the amount of displacement and angulation was not exactly quantifiable on radiographs only. Hence an arthrogram was planned. Intra operative use of radio opaque dye injection into elbow joint delineates the radial head and capitellum. It helps in identifying the fracture morphology and will also assist in reduction. We reduce radial head by K wire leverage technique and the intramedullary elastic titanium nail was added to assist in reduction and to improve fixation stability. We recommend arthrogram to be a safe and reliable option for proper assessment and reduction of radial neck fracture in an unossified radial head.